DocuSign Envelope ID: E6BC24D5-AD41-4104-B976-35DB9655CDC0

SCHOLARSHIP RECIPIENT DISCLOSURE

The Federal Family Educational Rights and Privacy Act (FERPA) protects the privacy of
student educational records that Rider University maintains about me. By signing below, I give
permission for Rider University to disclose to a financial aid review committee or scholarship
donors the information that I have provided for the purpose of the review of my scholarship
eligibility. Additional information that I permit Rider to provide may include my official
transcript, letters of recommendation, and financial aid information. I consent that this release
will remain in effect unless revoked by me in writing.

I understand that students at Rider University depend on the generosity of scholarship donors
who believe in the value of a Rider education, and that many donors appreciate hearing directly
from their scholarship recipients in order to learn about how their gift has positively influenced a
student’s life. For this reason, I also agree to write a letter of appreciation to my scholarship
donor(s) annually, attend an Annual Scholarship Luncheon in order to meet donors of any
scholarship(s) I receive, and have my photo taken if requested.

Name : Sienna Grinwald-Alves Bronc ID#: 006573129

Signature_______________________________________ Date______________________

For further information, please contact

Advancement Services, Rider University, Van Cleve Alumni House
2083 Lawrenceville Rd., Lawrenceville, NJ 08648
advserv@rider.edu / 609-896-5169

FOR ADMINISTRATIVE USE ONLY

Scholarship Name:_________________________________________ Date: ____________
Scholarship Name:_________________________________________ Date: ____________
Scholarship Name:_________________________________________ Date: ____________